ArticleOpen forum infectious diseases2021
Colistin Nephrotoxicity: Meta-Analysis of Randomized Controlled Trials.
Article in Open forum infectious diseases, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06650384 (Evaluation of the Efficacy and Safety of N-Acetylcysteine Versus Alpha-Lipoic Acid on the Occurrence and Severity of Colistin-Induced Nephrotoxicity in Critically Ill Patients), which is not on this map. Cited by 56 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Evaluation of the Efficacy and Safety of N-Acetylcysteine Versus Alpha-Lipoic Acid on the Occurrence and Severity of Colistin-Induced Nephrotoxicity in Critically Ill Patients
Who cites it
56 citing papers in PubMed, 1 synthesis or guideline pooled it, 81 citations in OpenAlex.
- Colistin monotherapy or combination for the treatment of bloodstream infection caused by Klebsiella pneumoniae: a systematic review and meta-analysis.BMC infectious diseases · 2024Pooled it
- Pharmacokinetics and Renal Safety Evaluation of Colistin Methanesulfonate Sodium in Korean Healthy Male Volunteers: An Open-Label, Multiple-Dose Study.Drug design, development and therapy · 2026Trial
- Evaluating the effects of intravenous magnesium sulfate for prevention of colistin induced acute kidney injury: an open-label, placebo-controlled, block randomized clinical trial.Naunyn-Schmiedeberg's archives of pharmacology · 2025Trial
- Is less always more? Ceftazidime/avibactam alone or in combination to treat infections caused by Pseudomonas aeruginosa: a retrospective observational multi-centre cohort study.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026Observational
- Deciphering synergistic killing mechanisms of capsaicin combined with colistin against colistin-resistantBiochemistry and biophysics reports · 2026Article
- Article
- Does a Loading Dose Improve Outcomes? Colistin Therapy for Urinary Tract Infections Caused by Multidrug-Resistant Gram-Negative Bacteria.Antibiotics (Basel, Switzerland) · 2026Article
- Cefiderocol nonsusceptibility among carbapenem-resistantAntimicrobial agents and chemotherapy · 2026Article
- From resistance mechanisms to therapy: Antimicrobial resistance in Gram-negative bacteria.Journal of microbiology (Seoul, Korea) · 2026Review
- Nanomaterial strategies for antibiotic-resistant infections: Mechanistic frameworks, rational design, and clinical translation.Materials today. Bio · 2026Review
- Cefiderocol activity against multidrug-resistant isolates from the PERSEUS study: relationship between cefiderocol minimum inhibitory concentration and clinical outcomes.The Journal of antimicrobial chemotherapy · 2026Article
- Safety Profiles of Polymyxins, Aminoglycosides, and Imipenem/Cilastatin/Relebactam (IMI/REL) in the Treatment of Gram-Negative Infections: A Literature Review.Antibiotics (Basel, Switzerland) · 2026Review
- Clinical Factors Associated with 90-Day Mortality in Patients Receiving Colistin Therapy for Multidrug-Resistant Gram-Negative Periprosthetic Joint Infection.Journal of clinical medicine · 2026Article
- Pharmacodynamic evaluation of BRII-693, a next-generation synthetic macrocyclic peptide antibiotic, in the neutropenic mouse thigh and lung infection models against gram-negative pathogens.Antimicrobial agents and chemotherapy · 2026Article
- Sulbactam-Durlobactam in the Treatment of Bloodstream Infection Due to Carbapenem-ResistantJournal of clinical medicine · 2026Review
- Antibacterial activity of lantibiotics, alone and in combination with colistin, against Gram-negative bacteria.Archives of microbiology · 2026Article
- Temporin-GHa-derived peptides enhance the antibacterial and antibiofilm activities of polymyxin B against Pseudomonas aeruginosa and Escherichia coli.Archives of microbiology · 2026Article
- Comparative in vitro analysis of sulbactam-durlobactam against extensively drug resistant (XDR) and non-XDR carbapenem-resistant Acinetobacter baumannii (CRAB) clinical isolates collected from a tertiary care facility in North India.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026Article
- Prevalence, clinical characteristics, and antibiotic resistance of carbapenem-resistant Klebsiella pneumoniae in a tertiary hospital in Türkiye (2023-2025).BMC microbiology · 2026Observational
- Comparative study on the wound healing effects of local versus systemic application of Polymyxin B in mice infected with multidrug-resistantFrontiers in microbiology · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 5 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundNephrotoxicity is a known adverse effect of polymyxin antibiotics, including colistin. Although previous meta-analyses have aimed to characterize colistin-associated nephrotoxicity risk relative to other antibiotics, included studies were observational in nature with high risk of confounding and heterogeneity. We conducted this systematic review and meta-analysis of exclusively randomized controlled trials (RCTs) to evaluate the incidence of nephrotoxicity associated with colistin versus minimally nephrotoxic antibiotics.
methodsWe searched PubMed, EMBASE, Cochrane Library, and 3 trial registries for RCTs comparing the nephrotoxicity of colistin to nonpolymyxin antibiotics. Randomized controlled trials that used aminoglycosides were excluded. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using random-effects models. The study outcome was the rate of nephrotoxicity.
resultsFive RCTs with a total of 377 patients were included. Most patients received colistin for pneumonia in the intensive care unit, and the comparators were β-lactam-based regimens. Colistimethate sodium was dosed at 9 million units/day (300 mg/day of colistin base activity), with administration of a loading dose in 4 studies. The nephrotoxicity incidence in patients who received colistin was 36.2% (95% CI, 23.3% to 51.3%). The nephrotoxicity rate was significantly higher in the colistin arm than comparators (RR, 2.40; 95% CI, 1.47 to 3.91;
conclusionsThis meta-analysis of RCTs found a colistin-associated nephrotoxicity rate of 36.2% and an increase in this risk compared with β-lactam-based regimens by 140%. Colistin should be regarded as a last-line agent and safer alternatives should be considered when possible.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.